Experiences from a Balint Group Intervention with Urban Public School Teachers

Background/Introduction

U.S. teacher shortages have more than tripled since the 2012-2013 school year, to over 110,000 teachers needed in 2016. ¹ At the conclusion of the 2011-12 school year, 13.8% of public-school teachers left their position ² . Approximately 50% of the public-school teachers cited the inability to manage their roles as the primary factor for leaving. ²

Open positions are largely filled with novice teachers, or those with less than five years teaching experience. ³ Such teachers enter the profession with limited resources and support in addition to lacking experience. ⁴ They face the challenge of meeting high-performance standards and performing instructional or managerial tasks at the level of their veteran peers while learning their new roles. ⁵ An exploration of the experiences of first year teachers identified 10 themes. ⁶ All themes align with occupational stress, or the accumulation of work-related stressors over time. ⁷ Occupational stressors can lead to burnout or total emotional exhaustion. ⁸ 40 percent (40%) of teachers experience burnout at some point in their career. ⁸ Forty one percent (41%) of teachers left their roles within the first five years of employment. ⁹ Ingersoll called this cycle of attrition the “revolving door effect”. ¹⁰ This study sought to explore the effectiveness of Balint groups in addressing the factors that lead to burnout and attrition among school teachers.

Psychoanalysts Michael and Enid Balint developed Balint groups to enhance the general practitioner’s understanding and management of the doctor-patient relationship. The goal of Balint is to enhance participant’s ability to recognize and promote intrapsychic and interpersonal skills needed for robust doctor-patient relationships. ¹¹ Balint groups are currently used in a wide variety of medical settings, including residency/fellowship programs across specialties, faculty groups, and among other mental health practitioners.^11-18 However, no published studies exist about the use of Balint groups among school-teachers.

Balint groups have between 4 and 10 members. The group meets according to a regular schedule, typically for 60–90 minutes. The Balint group is led by one or two people who have experience and/or certification in the method. During a group, a member presents a case from memory. Cases typically center around a patient who has elicited a difficult, memorable, or otherwise salient response from the presenting group member. The other group members attempt to understand the case from the patient and doctor’s perspective but avoid offering specific solutions or diagnoses. The case presenter meanwhile listens but does not participate in the discussion. This allows the presenter to reflect upon the discussion. Previous research indicates that participation in a Balint group can correlate with improved self-concept and relationships with patients.

Method

The purpose of this study was to examine the influence of participation in a 6-month Balint group experience on a novice teacher’s self-efficacy, experience with burnout, and intentions to persist in the classroom. The study centered on a teacher preparation program located in the Houston metropolitan area. The program itself recruits individuals to commit to teaching in low-income communities for 2 years. The questions guiding the study were:

• How did participants perceive their experience engaging in a 6-month Balint group?

A converged mixed-methods approach was used. Each question was explored with a corresponding qualitative and a quantitative dataset. Qualitative data included (a) a semi-structured focus group; (b) field notes shared from the co-facilitator and Balint group leader; (c) semi-structured debriefs with the Balint group leaders; (d) open-ended questions on the pre and post-test reflection forms, and () semi-structured interviews with three participants that served as a form of member checking. Quantitative data included pre and post-test and monthly reflection forms that were collected at the conclusion of each meeting. All forms used 5-point Likert scale questions. A descriptive approach was used due to small sample size. T-tests were used to analyze the significance of change in outcome constructs.

Eight teachers volunteered for the group after an email solicitation to all the teacher development program’s members (numbering about 100).

• seven female, one male

The group was scheduled to meet once a month, online, for 90 minutes on a Sunday from December 2020-May 2021 (six meetings), but due to Winter Storm Uri in February 2021, the group met five times. Two cases were presented each month. Practical elements of meeting online were addressed: joining in a confidential space, multitasking, and making sure video was turned on.

Results

An initial needs assessment of the 100 teachers in the cohort revealed sources of stress similar to those experienced in medicine, where Balint groups had previously been conducted:

• long work hours completing administrative tasks

Several themes came up in the case presentations:

• difficulties building relationships with students in a manner that promotes learning: “Have I taught the student at all?”

Discussion

In this pilot study, Balint groups were employed among a novel population, public school teachers. The results indicate that this sample experiences stressors similar to professionals in the medical field, historically the target audience for Balint groups, and that Balint offers an opportunity to address social and emotional needs they face.

Specifically, one of the recurring themes of case presentations related to the concept of self-efficacy, with regards to both locus of control and perceptions around building relationships with students in a manner that promotes learning. Interestingly, experiences with burnout increased over the six month experience. It is not possible to attribute this trend to the Balint group itself, as the meetings occurred infrequently compared to the day to day work of being a teacher, but the goal of the group is to improve self-awareness and develop insights into the relationship the individual has with others. The post-test scores indicate an improvement in understanding in locus of control and perceptions in efficacy in instructional strategies; it is possible that teachers were able to better appreciate the nuances in their ability to relate to particular students, and in turn, tailor pedagogical styles to better meet their needs. Nevertheless, it appears that the Balint group itself did not help to have teachers feel more comfortable in their role as it pertains to the larger educational system.

Another key component of the Balint process is being part of a group. These teachers transitioned from a traditional in-person classroom environment, to a fully virtual one abruptly as the pandemic associated lock-downs began. The isolation of being at home and away from a group of colleagues and students prevented a previously essential part of teaching: direct human connection. This Balint group, even itself conducted virtually, provided an opportunity for teachers to validate the emotions that come from the work and its intersections with the changing world around them, and this was reflected in themes that came up of feeling part of a community.

One teacher noted that Balint group participation changed the perception this individual had about the desire to commit to the teaching profession. It is difficult to extrapolate information beyond the individual, but it does speak to the force a collective effort such as Balint can have in individuals to reaffirm their goals, and in a profession with attrition as high as it is, this is an important point to highlight.

This is a pilot study, and by its nature, it had many limitations. The group itself was small and self-selected. It was not possible to randomize and run a control group. As such, it is better suited to consider additional research questions than to form conclusions. Further research would benefit from a controlled group where teachers undergo more curriculum driven psychosocial support practices. Additionally, while fidelity to the Balint method was strong, the group itself met relatively infrequently due to external circumstances, and as such, further experiments benefit from more frequent, regular meetings.